Urachal adenocarcinoma has come to the limelight of surgical practice during the last three decades. Due to the rarity of this tumour, the complete biological behaviour and treatment protocols have not been developed. This is a case report of a 22-year-old female who was diagnosed with urachal adenocarcinoma and underwent radical surgery with adjuvant chemotherapy based on a multidisciplinary team meeting. This is the youngest case reported from India.

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The COVID-19 pandemic has resulted in increased workplace demands from the health-care workers. This along with other psychosocial factors has resulted in increased stress, anxiety and depression. Measures have to be adopted to prevent burnout in the long run. There are various strategies that can be taken at the individual, administrative and community levels to mitigate stress. Everyone involved in healthcare from frontline workers to administrators and policymakers should be aware of the reasons for stress and strategies to mitigate it. A combined effort would decrease the inevitable toll on the health system. Strategies at individual, administrative and community levels can decrease the stress on health-care workers.

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Treatment for hemodynamically stable patients is mostly nonoperative observation, with increasing use of splenic angioembolization (SAE). There is a lack of consensus on management plan and use of SAE. In this review, relevant recent literature is analyzed to evaluate the failure rates, complications, mortality, and hospital length of stay for each management method. The analysis of 6299 patients from 9 studies showed that SAE decreased failure rates (1.3%) against nonoperative management (NOM) with 9.8%. There was no significant difference in mortality and hospital length of stay between SAE and NOM. There was increased complications with SAE but it is not enough evidence to draw comparisons between NOM and operative management (OM) due to heterogeneity of studies. SAE decreased need for splenectomies, reduced hospital stay, and complications. OM should be used if the patient is hemodynamically unstable or re-bleeds after NOM. It is imperative that clinicians assess each patient individually and follow a center-based protocol, while keeping in mind, the possible complications from NOM and subsequent interventions. Interventional radiologists will also need to approach SAE with care to prevent technical failures and re-intervention.

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Background: Patients often demand laparoscopic procedures irrespective of the indications. There seems to be an increased awareness of laparoscopic procedures among the people of Kerala. To date, there is no published study about the patient's awareness, perceptions and understanding of laparoscopic surgery in India. Aims: The aim is to assess the knowledge and identify various factors associated with the patient's perception of laparoscopic surgery. Methodology: This is a prospective cross-sectional study, including 200 participants. Kuppuswamy's Scale was used to assess the educational and occupational status of the participants. Knowledge scoring was obtained utilising a structured questionnaire. An initial survey divided patients into two groups, namely, those who were aware of laparoscopy and those who were not. Patients who were aware completed the remaining questionnaire. Others were briefly educated about laparoscopy, using print and visual aids. They were then assessed for their preference for the surgical procedure. Results: Awareness about laparoscopic surgery was high (96.5%). Friends and family (62%) contributed a major source of information and the least by the media (11.5%). 30.5% did not know that laparoscopy required special equipment. Interestingly, 56.5% were unaware of the requisite of gas insufflation. Educated participants had significantly better awareness. 55% had a good knowledge score. About 81.5% claimed their preference for laparoscopic surgery even if it were to cost more. Conclusion: The local population are well informed about laparoscopic surgery. The disadvantages are less known. Awareness through mass media is less. Health-care providers should focus their attention on deficient areas of awareness.

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Well-differentiated thyroid cancers are usually managed by total thyroidectomy with or without neck dissection. High-risk patients are followed up using serial thyroglobulin estimation and radioiodine scans. The phenomenon of dedifferentiation is essential to understand the events during post-operative follow-up of these tumours. This article describes the cascade of sequential dedifferentiation, its genetic undercurrents and its impact on the detection and treatment of post-surgical recurrences. New targeted agents aimed at redifferentiation are also discussed.

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Background: Many surgeons routinely use drains after thyroidectomy. The present study aimed to analyse and compare the immediate post-operative outcome in patients undergoing total thyroidectomy with and without placement of drain. Materials and Methods: A comparative observational study was conducted in 30 patients who underwent total thyroidectomy. They were randomly allocated to drain and no drain group post-operatively, with 15 subjects in each group, and the immediate post-operative outcome was assessed on day 0, day 1 and day 3 post-operatively, based on five parameters – post-operative pain, duration of hospital stay, haematoma formation, seroma formation and wound infection. The results were analysed statistically with Chi-square test and Mann–Whitney U test. Results and Discussion: Mean age of the participants was 36.07. All were females. There was association between post-operative pain and placement of drain, pain being less in participants without drain. Post-operative drain had no added advantage in preventing haematoma. None of the study subjects developed wound infection following thyroidectomy in any of the categories. There was a significant statistical association between the two groups based on hospital stay, and patients without drain were discharged earlier when compared to the patients with drain. Conclusion: Routine drain placement after thyroid surgery is not necessary, as thyroid surgery without the drain decreased the length of hospital stay without increasing patient morbidity. Placing of drain increased post-operative pain significantly.

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Introduction: Catheter-related bladder discomfort (CRBD) is a distressing symptom due to bladder spasm occurring in patients who are on catheter. This study was conducted to evaluate the efficacy of intravesical Oxybutynin as an alternate to the existing treatment for the management of CRBD. Materials and Methods: Two hundred and thirty four patients requiring bladder catheterization for >48 h following various surgeries were randomized into three groups of 78 each, once they developed CRBD. Group OO (Oxybutynin) received oral oxybutynin 5 thrice a day, Group OS (Solifenacin) received oral Solifenacin 10 mg once a day and Group OI (intravesical Oxybutynin) received Oxybutynin 5 mg dissolved in 30 ml normal saline instilled intravesically. The bladder discomfort was assessed according to visual analogue scale at 1, 6 and 24 h after drugs administration. The relief in CRBD and the side effects of the drugs were compared. Results: Out of 234 patients, relief of CRBD observed with intravesical oxybutynin was higher (87%) as compared to oral Oxybutynin and oral Solifenacin (66.3% and 74.3%, respectively; P < 0.05). OO group had maximum side effects and intravesical group had least side effects. Conclusions: Intravesical Oxybutynin therapy is a better option for the management of CRBD with minimal side effects.

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Introduction: Non-melanoma skin cancers (NMSCs) with lymph node involvement usually have aggressive clinical course with high rate of treatment failure and recurrence. Materials and Methods: The aim of the study was to find out the clinicopathological factors affecting lymph node involvement in NMSC. This study with 48 cases was conducted over a period of 1 year (May 2018–May 2019) in the histologically proven patients of NMSC of the general surgery department. Results: Lymph node-positive patients with and without prior lesions (chronic non-healing ulcers) were 12.5% and 10.4% of the total population, respectively. Conclusions: Of all factors affecting lymph node involvement assessed in this study, the presence of pre-existing lesions was the only one attaining statistical significance.

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Portal hypertension is managed using pharmacological, endoscopic and interventional radiology. Shunt surgery is used in selected patients with good long-term prognosis. We present a patient who underwent a left adrenalectomy and splenorenal shunt.

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Perinephric extravasation of urine with subsequent urinoma formation is a rare complication of neglected, obstructing ureteric calculi. It is associated with symptoms such as fever, lumbar pain and vomiting. We present the case of a minimally symptomatic patient who had an obstructed left upper ureteric calculus causing left hydronephrosis and a large perinephric urinoma, which probably was acting as a pop-off mechanism. Our patient was successfully managed by ureteroscopic lithotripsy with double J stenting.

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Local flap reconstruction of the perineum and anal canal is an excellent method of managing large perineal defects. Benefits of V-Y flaps compared with other methods such as vertical rectus abdominis myocutaneous include reduced donor-site morbidity and increased ease of harvest and inset. This is a case report of bilateral gluteal V-Y fasciocutaneous reconstruction of perineal defect, in a post-irradiated anorectal carcinoma patient, with excellent outcome.

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Introduction: Central venous pressure (CVP) catheterisation is an important procedure in emergencies. The complications associated with it are common. This article aimed to study the rate of mechanical complications of CVP catheter insertion in 201 patients. Materials and Methods: This was a prospective longitudinal study. Patients were aged above 13 years of both sexes who had CVP catheter introduced. Patients with complications before the procedure and those who had structural malformation of chest wall, bleeding disorders, etc., were excluded from the study. Consecutive sampling was performed. Data were analysed using Chi-square test for testing the strength of association in SPSS version 19.0. Results: The common indication for CVP line was lack of peripheral access (57.2%). Majority had right-sided (81.6%) catheter insertion and 56.7% had multiple percutaneous punctures. A statistically significant association was found in patients with body mass index >25 kg/m², in the occurrence of multiple percutaneous punctures (P = 0.04). Multiple punctures were associated with complications (P < 0.05). We observed 12.9% of mechanical complications – failure to place the catheter (8.5%), arterial puncture (6%), pneumothorax (2%) and haematoma (1%). Multiple complications were observed in 3.9% of patients. Conclusions: Factors contributing to various complications were number of punctures, presence of comorbidities and female gender.

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Introduction: Breast abscess is a common cause of morbidity in women. Ultrasound-guided needle aspiration, as opposed to formal I&D, is becoming the standard of care for most breast abscesses. This study aimed to establish whether ultrasound-guided aspiration is a comparable option to incision and drainage for breast abscess and to study the microbiological profile and antibiotic sensitivity pattern observed in breast abscess. Materials and Methods: Fifty females aged 20–40 years with breast abscess were analysed, of these 25 patients had ultrasound-guided needle aspiration (Group A) and 25 patients had incision and drainage (Group B). Group A patients were followed up on days 3, 7 and 14 by both clinically and radiologically (US), with repeated aspirations done on day 3 and 7. The presence of breast abscess on day 14 was considered as treatment failure, for whom incision and drainage was performed. Group B had incision and drainage done, followed up at 2 weeks. Scar length was assessed at 12 weeks for Group A and B. The results were statistically analysed. Results: The mean age of Group A was 31 and Group B was 30. Out of the 25 in Group A, 88% underwent resolution with no scar and 12% had failure. 100% of the patients in Group B had resolution, but had a definitive scar. Conclusions: US-guided aspiration of breast abscess is a comparable treatment option in the management of breast abscess as opposed to incision and drainage with the added advantage of minimal or no scar.

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Sacrococcygeal teratoma (SCT) is an unusual congenital tumour that arises from embryologically multipotent cells in the Hensen's node, which is located in the coccyx. Neonatal SCT is rare, with an incidence of one in 35,000 live births with a female predominance (3:1–4:1 ratio). It generally presents in two distinct fashions: (a) Newborns with large predominantly external masses, which are noted in utero or at the time of delivery and are rarely malignant, and (b) older infants and young children presenting with tumours predominately confined to the pelvis with a much higher rate of malignancy. Most SCTs are diagnosed prenatally because of the routine obstetric ultrasonography. Here, we are reporting the case of newborn with SCT presenting as external mass.

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Introduction: Laparoscopic appendicectomy is being adopted by majority of general surgeons, but its advantages over open appendicectomy, considering the cost difference, have not been established. This study aims to describe the difference in outcome between the two procedures and compare the costs involved. Materials and Methods: Seventy patients were studied with 35 in both laparoscopic and open appendicectomy groups. The two groups were compared for operation time, post-operative complications, pain, duration of hospital stay, days to return to work, quality of scar and costs involved. Results: Laparoscopic appendicectomy group had shorter operation times, lower post-operative pain, shorter hospital stays and better scars, whereas the open appendicectomy group had lower costs. No significant difference was observed in days to return to work or post-operative complications. Conclusion: Laparoscopic appendicectomy offers considerable advantages compared to open appendicectomy despite the higher costs.

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Introduction: Renal transplantation has become a common treatment for end-stage renal disease. The surgical techniques for renal transplantation are well established and associated with high success rates. Complications of the procedure are low (15%–17%) when compared to other solid organ transplants such as liver and pancreas. Surgical complications of renal transplantation are mostly related to either surgical site infection or problems in one of the three anastomoses (renal artery, renal vein or ureter). Most of the complications require prompt surgical or radiologic intervention for appropriate management. Materials and Methods: This is a retrospective observational study of surgical complications in patients undergoing live-donor renal transplantation for a period of 10 years before 2020 in the urology department of a tertiary care hospital. The incidence and potential reasons for the complications were analysed and reviewed. Results: Of the 250 cases reviewed, surgical complications were observed in 20 (8%). Among these, ureteric necrosis, arterial thrombosis and significant symptomatic lymphocele were the main surgical complications. Through this study, a causal relationship was established in all these patients with complications and preventive measures have been suggested. Conclusions: Surgical complications of live-donor renal transplantations could be reduced by adopting appropriate precautionary measures. Early identification and treatment of surgical complications are critical for graft survival after kidney transplantation.

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Introduction: The most common complication of burns is infection-producing sepsis. Therefore, it is necessary that septicaemia be diagnosed early. Many biomarkers help to diagnose septicaemia early. Serum albumin levels and total leucocyte counts were commonly measured blood parameters in burn patients. This study was undertaken due to the dearth of information on the role of serum albumin levels and total leucocyte count in the diagnosis of septicaemia. Materials and Methods: This retrospective, correlational study used existing medical record data of 60 patients including the laboratory values admitted in the burns intensive care unit of the department of general surgery during the period January 2017–May 2019 and during the follow-up period. Results: Statistically significant association was observed between low serum albumin values and positive blood culture (P < 0.0001). Mean serum albumin had an excellent predictive validity in predicting blood culture indicated by area under the curve of 0.907. Similarly, septicaemia was correlated with a high total number of leucocytes and a statistically significant correlation (P < 0.0001). In predicting blood culture, mean total leucocyte counts demonstrated excellent predictive validity indicated by area under the curve of 0.985. Conclusion: Serial monitoring of serum albumin and total leucocyte count could be used in burn patients to predict septicaemia.

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Background: Hernias are among the oldest known afflictions of humankind, and surgical repair of the inguinal hernia is one of the most common general surgery procedure performed today. Despite the high incidence, the technical aspects of hernia repair continue to evolve. We conducted a unicentric prospective study to compare the outcome of laparoscopic mesh repair and open Litchtenstein's mesh repair. Methods: We included a total of 80 cases who were diagnosed to have uncomplicated inguinal hernia and underwent surgical management electively for the same. They were randomized into both open or laparoscopic repair groups and results compared. Results: Among the 2 groups, the laparoscopic repair group had significantly low early post operative pain, low complication rate, early return to work and better cosmetic outcome. However, late post operative pain and duration of hospital stay did not show any significant difference between the two groups. Conclusion: Laparoscopic hernia repair offer significant advantages in terms of early post operative pain, early return to work and better cosmetics. But, in 2020, it still accounts for the minority of hernia repairs performed in India because of increased operative times, increased costs, and a longer learning curve. In addition are concerns about the need to use general anesthesia for laparoscopic operations. To summarize, there is no universal repair for groin hernia and no two surgeons will disagree to agree on that point.

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Introduction: Minimally invasive surgery has revolutionized thoracic oncology. Although there are various nonsurgical methods of biopsy, some patient's require a surgical biopsy. We present an innovative use of laparoscope for thoracoscopic biopsy. Materials and Methods: This is a retrospective analysis of 33 patients who underwent thoracoscopic biopsies for undiagnosed thoracic lesions in our hospital. Diagnostic thoracoscopy was performed with the laparoscopy unit used for abdominal surgeries. Results: Thoracoscopic biopsy yielded a histopathological diagnosis in 32 patients (96.67%). Median surgery duration was 40 min. Conversion rate was 6%. Morbidity rate was 10.7% with no mortality. The sensitivity and specificity of thoracoscopic biopsy was 95.83% and 100% respectively. The positive predictive value was100% and negative predictive value was 90%. Conclusion: Thoracoscopic biopsy using the laparoscopy unit can be done with minimal morbidity and without any additional financial burden in a low resource setting.

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Introduction: There are many choices for an areteriovenous (AV) access such as central venous catheters used in emergency basis, arteriovenous fistula (AVF), prosthetic AV grafts and vein interposition. Of these, AVF are used the most. It is very essential for surgeon to know about the merits and demerits of the same. Hence, this study was undertaken as a humble attempt to study the patency and complication rates of AVF. Materials and Methods: Eighty patients with chronic kidney disease who had an AV access created for dialysis in the given time period were included. They were assessed for fistula patency following the surgery at 1^st month and 6 months clinically and correlated with pre-operative parameters and demographic profile. Results: Patency of AVF at 1 month was 88% and at 6 months was 85%. There was a negative correlation between diabetics and patency which is statistically significant. There was a positive correlation between gender and patency. Males (90%) had patency, whereas 30% of females did not have patency. There was a strong association between diabetics and infection which was statistically significant. Conclusions: Autogenous AVFs are a safe durable option for renal replacement therapy and with due care, complication rates and patency can be maintained with international standards.

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Introduction: Identification of a small amount of free intra-abdominal gas remains one of the most significant signs in a perforated viscus. This paper tried to evaluate the sensitivity of chest radiographs in the detection of hollow viscus perforation and to compare the sensitivity of left lateral decubitus view and chest radiograph posteroanterior (PA) view in the detection of pneumoperitoneum. Methodology: Diagnostic validation study was conducted in sixty patients with clinical signs of peritonitis and strongly suspected to have perforation were evaluated with chest radiograph PA view and left lateral decubitus view in search of pneumoperitoneum and confirmed during laparotomy. Results: Out of sixty patients, 54 had gastrointestinal (GI) perforation and 42 out of those 54 were diagnosed in plain chest radiograph. Rest 12 required contrast enhancement computerised tomogam for diagnosis. There was only one case reported with chest radiograph showing pneumoperitoneum and the patient without any breach in the GI tract. Thirty patients with perforation took a left lateral decubitus view which showed free air only in 23 cases. Conclusion: Sensitivity of left lateral decubitus was around 76.6%. Overall, the sensitivity of plain chest radiograph in diagnosing perforation was 77% with specificity 83%, positive predicative value 97.6%, negative predicative value 29.4% and an accuracy of 79.6%.

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